Many prescriptions are sent electronically to the pharmacy. However, incorrect routing of discontinued medications continues to be a problem. This increases the risk of medication safety incidents. In an abstract that was presented at the American College of Cardiology Quality Summit Virtual which will take place September. 29 through Oct. 1 2021, Intermountain Healthcare examined several ways to notify community pharmacy staff about canceled medications, which could prevent nearly 200 safety events over two months.
There is currently no optimal method to inform a pharmacy that a clinician has discontinued medication for a patient, often leading to a medication being discontinued or an incorrect dose to be refilled and leading to confusion for the patient. Patients are at risk of taking medications that are no longer indicated or at the wrong dose that has vital precautions for safety of the medication.”
Jeffrey A. Goss FNP-c MSN, APP Director for Heart Failure for Intermountain Healthcare Murray, Utah and one of the study’s authors.
The study was intended to discover the reasons why communication between pharmacies on canceled medications was not taking place and identify the best way to communicate those changes from the patient encounter to the pharmacy. Intermountain Healthcare experienced a number incidents that could be considered unsafe, including the taking of discontinued medications with new medications and hospitalization.
Initially the team at Intermountain Healthcare tried temporary fixes that included clinical staff (registered nurses or pharmacists) personally calling the pharmacy to inform them of changes in medication and requesting that the medication be removed from the patient’s profile. Clinicians were also requested to provide evidence of changes to medications in the “comments” box of prescriptions sent electronically to pharmacy personnel. This included capturing information like “this prescription replaces this one” …,” but not all pharmacies are aware of this information, and it was not an accurate method of communicating.
16 specialists from the Intermountain Medical Center Advanced Heart Failure/Transplant Team turned on CancelRX functionality within their electronic medical records system over 60 consecutive days. CancelRX allows the pharmacy to be notified of a drug that has been discontinued, just like it would a new prescription. The functionality was initially turned off due to the large number of error messages sent to clinicians. It is also dependent on the pharmacy having this functionality turned on to receive the messages.
In the CancelRX trial, the Intermountain Medical Center Advanced Heart Failure/Transplant team tracked a totally of 558 medications that were discontinued. The team received 359 error messages and made 148 calls to pharmacies. In all, 196 possible dangers were avoided by both phone calls and CancelRX during the trial of 60 days. Intermountain Pharmacies (210), Smiths (1117), Walgreens (38) Walgreens (38) Costco (25) CVS (23) were the chains and pharmacies that received errors were reported.
“Effective communication between the doctor and the pharmacy is paramount to ensure that patients receive d medicines they require. In addition to the security implications, this will also reduce the likelihood of a patient buying a discontinued prescription, resulting in savings for patients and insurance payers,” said Steven Metz, PharmD, BCPS, Advanced Clinical Ambulatory Care Pharmacist, Intermountain Healthcare in Murray, Utah, and one of the study’s authors.
The study found that patients who are prescribed the correct medication based on their physician guidelines have better outcomes. To reduce the risk of errors in the treatment of patients they suggest that health systems review how their electronic medical records system connects with local pharmacies.
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